Health Screening Form Junior School
This form must be completed by a parent in the MORNING before your child attends Trail Ridge Montessori School.
This form must be completed NO LATER then 7:30 AM EVERYDAY.
Children will NOT be permitted to enter the school unless this form is completed.
You may complete one form for two children, UNLESS you have children at BOTH schools in which case a separate form must be complete for each using the correct link.

The responses you provide will be used to determine your child’s eligibility to enter the program on the current day. The health of children, families and staff who access this child care program depends on your honesty and accuracy in completing this screening tool.

If you answered “YES” to question 2 or 3 do not go to school or child care.
-The student/child must  isolate (stay home) for 14 days and not leave except to get tested for a medical emergency.
-If you answered  “YES”  to question 2 follow the advice of public health  The student/child can return to school/child care after they  are cleared by your local public health unit.
-If you answered “YES” to question 3, talk with a doctor/health care provider to get advice or an assessment, including if they need a COVID-19 test.  The student/child can return to school/child care only after 14 days even if you get a negative test result.
-Siblings and other people in your household can go to school, child care or work but not leave the home for other non-essential reasons.  Ask your school/child care for more information.
-If they develop symptoms or test positive, contact your local public health unit or doctor/health care provider for more advice.
-Contact your school/child care provider to let them know about this result.

If you answered “YES” to question 4 do not go to school or child care.  
-You must self-isolate (stay home) and not leave except for a medical emergency.
-Follow the advice of public health.  You can return to school/child care after you are cleared by your local public health unit.
-If you develop symptoms contact your local public health unit or doctor/health care provider for more advice.
-If you live in other areas of Ontario, other people in your household can go to school, child care or work but not leave the home for other non-essential reasons.  Ask your school/child care for more information.
-Contact your school/child care provider to let them know about this result.

If you answered “YES” to any of the symptoms included under question 1 or question 5,  do not go to school or child care.
-The student/child must isolate (stay home) and not leave except to get tested or for a medical emergency.
-If you answered “YES” to question 1, talk with a doctor/health care provider to get advice or an assessment, including if the student/child needs a COVID-19 test.  
-If you answered “YES” to question 5, the student/child can return to school/child care after the individual  gets a negative COVID-19 test result, or is cleared by your local public health unit, or is diagnosed with another illness.
-Siblings or other people in your household must stay home until the student/child showing symptoms or individual gets a negative COVID-19 test result, or are cleared by your local public health unit or are diagnosed with another illness.
-Contact your school/child care provider to let them know about this result.

If you answered “NO” to all questions, your child may go to school/child care because they  seem to be healthy and have not been exposed to COVID-19.

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Email *
Child(ren)'s First and Last Name * *
What class is your child in? *
1. Does your child have any of the following new or worsening symptoms? Symptoms should not be chronic or related to other now causes or conditions. *
Yes
No
Fever and/or chills
Cough (more than usual if chronic) including croup (barking cough, making a whistling noise when breathing) Not related to other known causes or conditions (e.g. asthma, reactive airway).
Shortness of breath (dyspnea, out of breath, unable to breathe deeply, wheeze, that is worse than usual if chronically short of breath) Not related to other known causes or conditions (e.g. asthma)
Decrease or loss of smell or taste (new olfactory or taste disorder) Not related to other known causes or conditions (e.g. nasal polyps, allergies, neurological disorders).
Sore throat (painful swallowing or difficulty swallowing)
Stuffy nose and/or runny nose (nasal congestions and/or rhinorrhea) Not related to other known causes or conditions (e.g. seasonal allergies, returning inside from the cold, chronic sinusitis unchanged from baseline, reactive airways).
Headache that is new and persistent, unusual, unexplained, or long-lasting. Not related to other known causes or conditions (e.g. tension-type headaches, chronic migraines).
Nausea, vomiting and/or diarrhea
Fatigue, lethargy, muscle aches or malaise (general feeling of being unwell, lack of energy, extreme tiredness,) that is unusual or unexplained.
2. Has your child travelled outside of Canada in the past 14 days? *
3. Has your child been identified as a close contact of someone who is confirmed as having COVID-19 by your local public health unit? *
4. Has your child been directed by a health care provider including public health official to isolate? *
5. If someone that the student/child lives with is experiencing symptoms of COVID-19 and/or waiting for test results after experiencing symptoms or been recommended for isolation and testing? (If the individual experiencing symptoms received a COVID 19 vaccination in the last 48 hours and is experiencing mild headache, fatigue, muscle aches and/or joint pain that only began after vaccination select 'NO').
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Parent or Guardian First and Last Name *
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